20 世紀初頭イギリスにおける国家的結核対策の成立

<p>This paper aims to re－examine the historical significance of the national tuberculosis measures established in early 20th century Britain. The particular focus is on the process by which the Sanatorium Benefit under National Health Insurance was remade into part of a comprehensive tuberculosis scheme, applicable to the entire population and organized by local authorities immediately after passage of the 1911 National Insurance Act.</p><p>The Local Government Board had already begun to make notification of tuberculosis compulsory in the early 20th century. The Board and local authorities therefore strongly opposed the proposal for a Sanatorium Benefit that would be administered by completely new local Insurance Committees independent of the Board. They feared that the plan would conflict with the duties of local health authorities. Opponents also insisted that social insurance was not appropriate for dealing with tuberculosis because it is an infectious disease that tended to affect poorer people. Organization of national tuberculosis measures was accordingly transferred from local Insurance Committees to local authorities, and this in turn made it available to the whole population.</p><p>To be sure, the administrative structure of the comprehensive plan became complex and inefficient because Lloyd George refused to remove the Sanatorium Benefit from it. However, it should be noted that half the cost of the plan was to be paid by the Exchequer. Lloyd George hoped through the National Insurance Act to support and promote the efforts of the local authorities and voluntary bodies, which had hitherto been inadequate, and the form of that assistance also represented continuity with the comprehensive plan.</p><p>This paper also examines the expected role of general practitioners and voluntary bodies such as sanatoria and tuberculosis dispensaries in the national plan and the reactions of the medical world to state intervention in the treatment of the disease. This contributes to our understanding of the continuities and discontinuities of the practice of private welfare in the advent of the state welfare.</p>